To provide education for health care professionals on appropriate and effective communication with the geriatric population, as well as additional resources for both the healthcare professional and the patient to enhance the process
Learning objectives
Discuss why effective communication can lead to better healthcare outcomes in the geriatric population
Discuss common barriers to communication in the geriatric population
Present general strategies for appropriate communication to geriatric patients
Provide additional resources for the elderly patient to improve their healthcare experience
Provide additional resources for the healthcare provider to enhance the communication process
Why is effective communication so important for the geriatric population? Within the healthcare profession it has become accepted that an appropriate plan of care and treatment is not solely responsible for a good patient outcome. A correlation between the patient’s perception of their healthcare providers communication and their adherence to their treatment has been established.1 The geriatric population is quickly growing in the United States, and it is estimated that by the year 2030 there will be 71 million Americans over the age of 65. People in this demographic require more frequent visits to healthcare professionals, so it is imperative that providers are aware of how to communicate best to these patients in order to optimize patient outcomes.4 In general, there is evidence that healthcare professionals are more condescending and less patient with older adult patients, and tend to provide less information to them. Older patients are also more likely to withhold information about their condition because they feel it is normal for their age, but this information may actually be helpful for the healthcare provider to know.3,5 By implementing some of the simple strategies outlined below this communication process can be made much more effective which will lead to better patient care and outcomes.
What are common barriers to effective communication between the geriatric patient and their healthcare professional?
Hearing Deficits2,5—Age related hearing loss is very common in this population, with 1/3 of people between the ages 65-75 affected. Presbycusis reduces their ability to hear high frequency sounds, and distinguish speech sounds.
Vision Deficits2,5—Vision changes affect 1 out of every 6 Americans 70 years of age and older. This affects their ability to read small print, scrolling print, and increased difficulty seeing in low light environments.
Language Comprehension5—Working memory decreases with age so geriatric patients may have slower information processing, especially with complex sentence structures and unfamiliar jargon.
Ageism3,5—We often rely on pre-established stereotypes when first encountering new people, and in this population it is often assumed that they have diminished intellectual capabilities. This “ageism” can be interpreted as demeaning towards the patient.
Guidelines for appropriate and effective communication
Use proper form of address2,5—Establish respect first with the patient by using formal language (Ms., Mrs., Mr.). Also try to avoid patronizing language and pet names such as “honey” and “dear.” This is termed “Elderspeak” and although it may be due to a desire to convey caring to the patient, the patient often views it negatively and feels that they are being treated like children.
Allow extra time for the interviewing process1-5—Older adults typically have more complicated medical problems, which can require a longer interview and evaluation process, as well as longer time to explain it thoroughly to the patient. Open ended questions may also be more helpful because the patient is more likely to divulge information they may have felt was unnecessary if not directly addressed. Moreover, if extra time is planned for the patient won’t feel that they are being rushed.
Sit face to face and maintain eye contact2,5—Because older adults are more likely to have sensory deficits it is important that they are able to see the provider’s face and lips and that they are within close proximity so they will be able to hear. This allows them to utilize nonverbal communication as well, and eye contact conveys engagement and investment in the conversation.
Active listening2,4—Good communication is based on good listening, so it is imperative that the patient feels they are being heard. By actively listening the provider may also be able to ask questions about topics the patient may not feel are important but can be helpful in creating a treatment plan. Research has found that doctors listen for an average of 18 seconds before interrupting, causing them to miss this possibly important information.
Speak slowly, loudly, and clearly2,4,5—Older patients may have slowed information processing so by speaking slowly the provider is allowing them time to comprehend their words. This technique can also help to overcome some of the sensory related deficits that older adults have and allow them to hear the information clearly.
Write down instructions4—This is a permanent form of communication and allows the patient to review the “take home messages” from the visit at a later time, as well as share it with spouses or caregivers who may be helping them.
Be aware of your nonverbal communication1,4,5—Nonverbal behaviors are communicating to the patient interest in the interaction. Research has found that positive facial expressions (smiling, nodding) are associated with an improvement in patient condition, emphasizing how importance they are to the patient.1 Also, many patients with sensory deficits rely on nonverbal communication throughout the exchange.
Resources for the Geriatric Patient
Includes forms for the patient to use to organize their most important complaints prior to visiting with their doctor, as well as a form for writing down all of their medications. Also includes general tips for how to have an effective visit with the doctor and ensure that their needs are met.
This resource provides information on the type of doctors available, how to search for a new doctor, and what questions they should be asking of new healthcare providers.
Additional Resources for the Health Care Professional
Ask Me 3 Program—This is an educational program that helps patients and families to understand their health condition and have a successful visit with their healthcare professional. It provides complimentary resources and materials for the healthcare provider to have available in their office to encourage patients to take control of their visit.
(3) Nussbaum, J. F., & Fisher, C. L. (2009). A Communication Model for the Competent Delivery of Geriatric Medicine. Journal of Language and Social Psychology, 28(2), 190-208.
(4) Robinson, T. E., White, G. L., Houchins, J. C. (2006). Improving Communication with Older Patients: Tips From the Literature. Family Practice Management, 18(8), 73-78.
Purpose
Learning objectives
Why is effective communication so important for the geriatric population?
Within the healthcare profession it has become accepted that an appropriate plan of care and treatment is not solely responsible for a good patient outcome. A correlation between the patient’s perception of their healthcare providers communication and their adherence to their treatment has been established.1 The geriatric population is quickly growing in the United States, and it is estimated that by the year 2030 there will be 71 million Americans over the age of 65. People in this demographic require more frequent visits to healthcare professionals, so it is imperative that providers are aware of how to communicate best to these patients in order to optimize patient outcomes.4 In general, there is evidence that healthcare professionals are more condescending and less patient with older adult patients, and tend to provide less information to them. Older patients are also more likely to withhold information about their condition because they feel it is normal for their age, but this information may actually be helpful for the healthcare provider to know.3,5 By implementing some of the simple strategies outlined below this communication process can be made much more effective which will lead to better patient care and outcomes.
What are common barriers to effective communication between the geriatric patient and their healthcare professional?
Guidelines for appropriate and effective communication
Resources for the Geriatric Patient
- Includes forms for the patient to use to organize their most important complaints prior to visiting with their doctor, as well as a form for writing down all of their medications. Also includes general tips for how to have an effective visit with the doctor and ensure that their needs are met.
http://nihseniorhealth.gov/talkingwithyourdoctor/planningyourdoctorvisit/01.html- This resource provides information on the type of doctors available, how to search for a new doctor, and what questions they should be asking of new healthcare providers.
https://www.nia.nih.gov/health/publication/choosing-doctor- This is a video created for older adults explaining what Medicare is, how to get insured, and how to determine what their insurance will cover.
http://nihseniorhealth.gov/medicarebasics/whatismedicare/01.htmlAdditional Resources for the Health Care Professional
- Ask Me 3 Program—This is an educational program that helps patients and families to understand their health condition and have a successful visit with their healthcare professional. It provides complimentary resources and materials for the healthcare provider to have available in their office to encourage patients to take control of their visit.
https://npsf.site-ym.com/default.asp?page=askme3- Guidelines on creating appropriate written materials for older patients to enhance communication
https://www.nia.nih.gov/health/publication/making-your-printed-health-materials-senior-friendly- American Geriatrics Society—General information on the Geriatric population and further resources
http://www.americangeriatrics.org/References:
(1) Ambady, N., Koo, J., Rosenthal, R., & Winograd, C. (2002). Physical Therapists' Nonverbal Communication Predicts Geriatric Patients' Health Outcomes. Psychology and Aging, 17(3), 443-452.
(2) National Institute on Aging. (2008). A Clinician's Handbook: Talking with Your Older Patient. https://www.nia.nih.gov/health/publication/talking-your-older-patient. Accessed May 10, 2016.
(3) Nussbaum, J. F., & Fisher, C. L. (2009). A Communication Model for the Competent Delivery of Geriatric Medicine. Journal of Language and Social Psychology, 28(2), 190-208.
(4) Robinson, T. E., White, G. L., Houchins, J. C. (2006). Improving Communication with Older Patients: Tips From the Literature. Family Practice Management, 18(8), 73-78.
(5) The Gerontological Society of America. (2012). Communicating with Older Adults: An Evidence-Based Review of What Really Works. http://aging.arizona.edu/sites/aging/files/activity_1_reading_1.pdf. Accessed May 15, 2016.